Radiation therapy for esophageal cancer

Radiation therapy uses high-energy rays or particles to destroy cancer cells. Radiation therapy is commonly used to treat esophageal cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.

Radiation therapy is often used as part of chemoradiation to treat esophageal cancer. Chemoradiation is treatment that combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy.

Radiation therapy is given for different reasons. You may have radiation therapy, usually as part of chemoradiation, to:

shrink a tumour before other treatments such as surgery (called neoadjuvant chemoradiation)

destroy cancer cells in the body (chemoradiation may be used as the primary treatment if you can’t have, or choose not to have, surgery)

destroy adenocarcinoma cells left behind after surgery and reduce the risk of the cancer coming back, or recurring (called adjuvant chemoradiation)

Radiation therapy may also be used alone to relieve pain or control the symptoms of advanced esophageal cancer (called palliative radiation therapy).

The following are the types of radiation therapy most commonly used to treat esophageal cancer.

External beam radiation therapy

Esophageal cancer is usually treated with external beam radiation therapy. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it. It is usually given 5 times per week for several weeks.

The healthcare team will very carefully plan radiation therapy for esophageal cancer. Several organs close to the esophagus can be damaged by radiation, including the liver, kidneys, lungs, spinal cord and heart. Special shields are made and used during external beam radiation therapy to protect other organs in the area as much as possible.

Brachytherapy

Brachytherapy is internal radiation therapy. It uses a radioactive material called a radioactive isotope. It is placed right into, or very close to, the tumour. The radiation kills the cancer cells over time.

Brachytherapy is often used in combination with external beam radiation therapy for esophageal cancer. The brachytherapy gives a boost of additional radiation. It may be given before or after external beam radiation therapy.

Brachytherapy may also be used as a palliative treatment in some cases. Palliative brachytherapy can slow the growth of or shrink the tumour, which can make it easier to swallow or stop bleeding.

Intraluminal brachytherapy for esophageal cancer

For esophageal cancer, iridium is the most common radioactive isotope used in brachytherapy. Doctors use an endoscope or nasogastric (NG) tube to place the radioactive implant inside the esophagus. This approach is called intraluminal, or transluminal, brachytherapy. Intraluminal means within a tube or passage in the body.

Doses of brachytherapy

Brachytherapy for esophageal cancer is given in low-dose or high-dose rates:

Low-dose rate (LDR) therapy delivers continuous, low doses of radiation over time (usually a few days). People who receive LDR therapy usually have to stay in the hospital and follow special radiation safety precautions to protect others.

High-dose rate (HDR) therapy delivers a single, high dose of radiation in a very short period of time. A single treatment usually takes a few minutes and you don’t need to stay in the hospital.

Questions to ask about radiation therapy

A thin, tube-like instrument with a light and lens used to examine or treat organs or structures in the body.

An endoscope can be flexible or rigid. It may have a tool to remove tissue for examination. Specialized endoscopes may have tools designed to examine or treat specific organs or structures in the body.

Specialized endoscopes are named for the organ or structure they are used to examine or treat.

nasogastric (NG) tube

A flexible tube (catheter) that is inserted through the nose, down the throat and esophagus, into the stomach.

An NG tube can be used to deliver nutrients, liquids or drugs directly into the stomach, or to remove the contents of the stomach.